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The Difficult Gallbladder: A Safe Approach to a Dangerous Problem.

B Fernando Santos1, L Michael Brunt2, Michael J Pucci3

  • 11 Department of Surgery, Dartmouth Geisel School of Medicine , Lebanon , New Hampshire.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|March 29, 2017
PubMed
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Laparoscopic cholecystectomy, a common gallbladder surgery, can be challenging. This review explores managing difficult gallbladders and proposes subtotal fenestrating cholecystectomy for safety.

Area of Science:

  • Surgical procedures
  • Gastroenterology
  • Biliary disease management

Background:

  • Laparoscopic cholecystectomy is the standard for benign gallbladder and biliary disease.
  • Despite its commonality, it can present significant surgical challenges.
  • A "difficult gallbladder" increases the risk of severe complications like bile duct injury.

Purpose of the Study:

  • To discuss the management of the "difficult gallbladder."
  • To propose subtotal fenestrating cholecystectomy as a safe option for difficult cases.

Main Methods:

  • Literature review on laparoscopic cholecystectomy safety.
  • Analysis of strategies for managing challenging operative situations.
  • Evaluation of subtotal fenestrating cholecystectomy as a surgical technique.
Keywords:
difficult gallbladderlaparoscopic cholecystectomysubtotal fenestrating cholecystectomy

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Last Updated: Mar 5, 2026

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Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture
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Main Results:

  • The "difficult gallbladder" necessitates a strong "Culture of Safety in Cholecystectomy."
  • Subtotal fenestrating cholecystectomy is presented as a viable solution for complex scenarios.

Conclusions:

  • Adherence to safety protocols is crucial for all laparoscopic cholecystectomies.
  • Subtotal fenestrating cholecystectomy offers a definitive approach to managing difficult gallbladders, enhancing patient safety.